NIHON KOHDEN Life Scope PT (BSM-1700 Series) Transport Monitor and Data Non-Continuity

Category: NIHON KOHDEN Life Scope TR (BSM-6000 series), Life Scope PT (BSM-1733, BSM-1753, BSM-1763, BSM-1773), Life Scope Telemetry, Life Scope J (BSM-9101) bedside monitor, Nihon Kohden SpO2 algorithm type, semi-quantitative Waveform, Host Monitor, MULTI connectors, discontinuous seamless monitoring, IntelliVue X2, patient monitoring

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In this knowledge-sharing record we examined the history and performance of the Life Scope BSM-1700 series transport monitors, noting the total absence of realtime data streaming during patient transport. The BSM-1700 monitor when changing from role of input unit of a host monitor to being an independent transport monitor should not compromise critical central monitoring connectivity at the system level.

Life Scope PT (BSM-1700 series) Transport Monitor

 

The Life Scope PT is a 5.5-inch transport monitor transformed from a multi-parameter Input Unit designed initially for configured Life Scope TR (BSM-6000 series) bedside monitors, and its use later extended to Life Scope J (BSM-9101) bedside monitor, Life Scope G9 (CSM-1901) bedside monitor, Life Scope G5 (CSM-1500 series) bedside monitors, and Life Scope G7 (CSM-1700 series) bedside monitors. The transport monitor was realized by the addition of touch-screen, storage memory and rechargeable battery to the multi-parameter input unit, doing away the need to attach it to a monitor during patient transfer; this means the Life Scope PT transport monitor can also act as an Input Unit for the mentioned bedside monitors, known as the Host Monitor. The design is an adaptation to imitate the Philips IntelliVue MMS X2; and because it is not a system design from scratch, something important at the system level is missing and the details will be discussed later in this same article.

 

Configured Input Units made into a Transport Monitors imitating Philips IntelliVue MMS X2

 

There are four models in the Life Scope BSM-1700 series transport monitors, namely

1. BSM-1773 transport monitor (Nihon Kohden older SpO2 algorithms)

2. BSM-1763 transport monitor (Nihon Kohden current SpO2 algorithms)

3. BSM-1753 transport monitor (OEM SpO2 board supplied by Nellcor)

4. BSM-1733 transport monitor (OEM SpO2 board supplied by Masimo)

The only difference among the four models is the SpO2 algorithms.

 

The four types of Life Scope PT transport monitors

 

The two models (BSM-1773 and BSM-1763) on the left make use of Nihon Kohden SpO2 algorithms and their main difference being the programmable ROM chip which contains the SpO2 algorithm slotted onto the SpO2 PC Board. It is not disclosed why the latest international version is refrained from use in the USA market.

The remaining two models on the right, namely BSM-1733 and BSM-1753 are using SpO2 OEM boards supplied by Masimo and Nellcor respectively.

 

Some sales people are very excited about the bigger screen of Life Scope PT in the market but there is little knowledge why the configured multi-parameter Input Units of Life Scope TR (BSM-6000 series) bedside monitors are so different and big that its sides can accommodate a 5.7 inch screen?

 

Why are the Input Units of Life Scope TR so big?

Many embedded patient monitoring hardware are avoided for mention in product communication to the market, and that was intentionally done to hide the fact the input units are configured.

 

Many internal hardware are not made clear in product communication to the market

It should be high-lighted the AY-663P Input Unit (or Life Scope PT transport monitor) makes use of a Multi-parameter Unit which has shared-use yellow MULTI sockets accessible only by NIHON KOHDEN coded measurement cables cited as Smart Cables.

There is a MULTI SOCKETS HARDWARE RULE not revealed to the market, dictating that each functional MULTI socket must always come with their own one-channel IBP hardware. This is the hardware unlock key to understand NIHON KOHDEN input units and monitors that make use of Smart Cables.

Knowing the MULTI SOCKETS hardware rule means that just by looking at the number of MULTI sockets on AY-663P Input Unit, we immediately know there are three built-in IBP amplifier hardware inside. With this insight, the rest of the hardware are easily arrived at after knowing all parameters that can be measured.

To divert your attention from the lack of a measurement-data network infrastructure, the MULTI sockets also double as serial ports without the need to access any hardware in the AY-663P Input Unit. This of course, is not cost-effective.

Looking at the below picture, we can tell the AY-663P Input Unit needs at least ten sockets for unconstrained use but only three shared-use MULTI sockets are provided. Why would any one accept an input unit that is so short of connector sockets?

A skewed input unit delivering pain of not having enough connector sockets

Electrically, the manufacturer can compensate for the missing sockets on the AY-663P Input Unit using an external box (AA-674P) filled with four yellow MULTI sockets. The manufacturer should have designed an input unit with enough connector sockets in the first place, but there is a reason for wanting to do it. The purpose is to imitate the process of scalability, so that the market can accept Life Scope TR as an authentic modular bedside monitor. With keen observation, you will notice there is a limit to the number of MULTI sockets that can be added.

Only up to a maximum of four MULTI sockets can be added to the AY-663P Input Unit

 

The limitation is due to the interface from AA-674P expansion box to AY-663P being analog type, not digital. The action of adding more MULTI sockets using the AA-674P expansion box also means adding four channels of IBP hardware to what are already embedded in the AY-663P Input Unit. Do you need seven channels of IBP hardware? This is how Life Scope TR bedside monitor got its maximum ability to do seven channels of IBP monitoring, and not from using imagined modules embedded inside seven pieces of IBP Smart Cables. The four MULTI sockets limitation also means only one AA-674P expansion box can be attached to the AY-663P Input Unit.

The AA-674P box compensates for four missing sockets but at the same time adds four channels of IBP hardware

Shown above is a Life Scope TR bedside monitor main unit (on the right) with the input unit (AY-663P) on the immediate left of its side. On the extreme left is a satellite box with four adapting MULTI sockets (AA-674P) that can also link to hardware already embedded in the Input Unit.

THE SMART CABLES ARE JUST MEASUREMENT CABLES EMBEDDED WITH A CODE

There is misunderstanding in the market that there are active electronics in the Smart Cables. The marketing messages "New Modular Technology" and "The Module is in the cable!" are wild imaginations.

What do the manufacturer mean by this statement? 

It started with the Life Scope TR (BSM-6000) series monitors in the USA market and gradually adopted officially for International markets.

This is just assertion without showing any proof

 

Chip makers need huge demand to justify each of their products, so which chip manufacturer is supplying NIHON KOHDEN the variety of analog chips given the extremely low volume in demand? If we were to open up the plug of a Smart Cable, what do we see?

 

Size of the PC Board relative to pins of the yellow connection plug

 

We found a cheap digital EEPROM chip being used to code the Smart Cable.

 

A cheap digital EEPROM chip was what we found inside the yellow Smart plug

If we were to open up the plug of the IBP cable from a China supplier, what do we see? It is the same thing.

Under US FDA rule, a cable is only a cable if it does not change the signal that passes through it. A Smart Cable with a hexadecimal code is just a cable and does not change a signal passing through it, but if it has an amplifier it becomes a medical device and requires FDA registration. Can you find any stand-alone Smart Cables registered as a medical device?

When the Smart Cables are used with serial kit sets, such as mainstream CO2 kit sets or the NMT AF-101P kit set, the registration is for the active serial kit set and not the passive Smart Cable. 

What are the hardware inside the AY-663P Input Unit?

 

The Input Unit is making use of coded measurement cables known as Smart Cables to time-share the yellow MULTI sockets. The patient monitoring hardware in the AY-663P Input Unit can be separated into two blocks.

(NORMAL BLOCK) The hardware using dedicated sockets and ordinary measurement cables:

- 2 channels of Temperature

- ECG

- SpO2

- NIBP

(MULTI-PARAMETER UNIT) The hardware sharing the three adapting MULTI sockets in this block only use Smart Cables for connections:

- 3 channels of IBP (3 MULTI sockets = 3-ch IBP)

- 2 channels of Temperature (1 MULTI socket = 2-ch TEMP)

- Cardiac Output

- FiO2

- Thermistor Respiration

Note:

1. The Number of MULTI sockets in the Multi-parameter Unit are already not enough for the hardware embedded for its primary role, yet they are also being utilized as serial ports.

2. The mainstream CO2, 2nd SpO2, BIS and NMT hardware come in the form of self-contained serial kit sets using the MULTI sockets as serial ports without need for any internal hardware. There is hidden motive for doing this.

The huge amount of hardware in the Multi-parameter Unit of AY-663P

In the AA-674P expansion box, the four MULTI sockets make use of their own IBP hardware when IBP monitoring is selected by the operator; for the other four parameters, the sockets can access and make use of the Temperature, Cardiac Output, FiO2 and Thermistor Respiration hardware already embedded in the Multi-parameter Unit of AY-663P Input Unit.

The hardware in the AA-674P expansion box

What value can the users capture from using input units that come with deficiency of connector sockets? The first vehement complaint from users is always the yellow MULTI sockets are not enough for use!

When a transport monitor is needed, Life Scope PT transport monitor being used as input unit instead of AY-663P. The main unit could be Life Scope TR, Life Scope G9 or Life Scope G5.

In the case of Life Scope TR and Life Scope G9, the add-on four MULTI sockets are delivered through the JA-694P Data Acquisition Unit while it is using an AA-174P expansion box for Life Scope G5 bedside monitor.

The Smart Cables were devised only to solve a product issue

The Smart Cables are coded cables connectable to modified sockets on a bedside monitor; sacrifices made to use them are also not revealed to the market and easily lead customers into having an unrealistic expectation of what the Smart Cables can actually deliver. 

In the 1990s, when developing the first digital modular monitor, the development team encountered a problem of insufficient front panel space for connector sockets on the first digital multi-parameter module being made. A few sockets were specially adjusted for time-sharing use by a group of five types internal analog hardware to overcome the space limitation; to differentiate them, they were colored yellow and known as MULTI sockets.

 

At the time NIHON KOHDEN was responding to an important emerging trend of using a high-density digital multi-parameter module as basic building block for modular monitors

 

 

In analog modular monitors, only single parameter modules were produced by NIHON KOHDEN. When designing the first digital modular monitor, the company discovered the critical care market had already moved to using a digital multi-parameter module with higher density of electronic components as a basic building block for modular monitors.

 

Apart from the higher electronic density, the difference between a single parameter module and a multi-parameter module is the presence of a CPU processor in the latter; the output of a multi-parameter module is thus processed digital data. This new development of distributed processing made it possible for patient data to be stored and moved with the module. Digital modules can also be connected directly to a (proprietary) digital data-exchange network as a node.

 

NIHON KOHDEN wanted to follow the trend by offering the first digital multi-parameter module, and the first digital multi-parameter module made by the company was named the Saturn module.

Responding to new trend in the 1990s using a multi-parameter module with higher electronic density as a basic building block for modular monitor

Even occupying a 3-slot width of the module rack, the Saturn multi-parameter module (August 1998) was not big enough to hold all necessary connector sockets

 

Nihon Kohden intended a module rack integrated physically with the main unit to form a limited footprint just big enough to stack the display monitor on top of it (see below illustration). The physical size of the Saturn module was therefore constrained; in addition, the multi-parameter module must work in combination with other parameter modules like recorder, sidestream CO2, BIS, EEG, Flow/ PAW, SvO2 in the module rack.

The Saturn module was intended to be physically small in size

 

The elegant but expensive solution from NIHON KOHDEN for the physical size limitation of the Saturn module was to modify two of the connector sockets for sharing use

 

Two sockets were modified for time-sharing use because there was not enough free space on the Saturn module for more sockets

The method selected by NIHON KOHDEN was to make use of coded measurement cable known as Smart Cables to share two modified connector sockets. The patient monitoring hardware were separated into two blocks in the Saturn module.

(NORMAL BLOCK) The hardware using dedicated connector sockets and ordinary cables:

- ECG

- SpO2

- NIBP

(MULTI-PARAMETER UNIT) The hardware sharing the two adapting MULTI sockets in this block only use Smart Cables for connections:

- 2 channels of IBP (2 MULTI sockets = 2-ch IBP)

- 4 channels of Temperature (2 MULTI sockets = 4-ch TEMP) 

- Cardiac Output

- FiO2

- Thermistor Respiration

Huge amount of hardware for two modified connector sockets

The adapting MULTI sockets were additionally allowed to be diverted to act as a costly digital serial ports so that mainstream CO2 digital serial kit sets can also use it; this being an easy task since no internal analog hardware is being involved.

The mainstream CO2 comes in the form of a self-contained serial kit set, utilizing the MULTI socket only as a serial port.

Remember this is for purpose of minimizing connector sockets on the Saturn multi-parameter module, as it does not make sense outside this context.

The label for the yellow MULTI socket indicated the five specific hardware plus mainstream CO2 using it as a serial port.

 

The label for the yellow MULTI sockets on the Saturn module

 

How to modify connector sockets for time-sharing use?

 

There are cheaper and more practical alternatives to solving the problem of insufficient space on the input panel, such as commonly integrating more than one signal onto a socket and using an external splitter to resolve the signals.

 

Example of resolving integrated signals to individual P1 and P2

 

So far, time-sharing of connector sockets is only done by NIHON KOHDEN and not repeated by any other leading manufacturers of patient monitors for obvious reasons.

It is foremost important to know the overall cost is very high to share connector sockets.

 

The connector sockets that were being time-shared are known as MULTI Sockets and colored yellow. The yellow MULTI sockets must be used in conjunction with coded measurement cables known as Smart Cables, and the plug of a Smart Cable has the same color as the MULTI sockets. The Smart Cables are each marked with a digital hexadecimal code to identify the purpose of the measurement cable (i.e. what parameter is being measured).

 

Overview

 

 

The digital code is stored in an EEPROM chip mounted on a small flexible PC board electrically wired to the pins of the cable plug. The hexadecimal code in the EEPROM is inserted at the factory and not allowed to change after production. It is actually not difficult to make the Smart Cables but they are being priced highly by the manufacturer; only the common IBP cable can be sourced from China suppliers at a reasonable price.

A code is stored in the plug of the measurement cable gives switching instruction to an engaged MULTI socket

 

The code in the plug makes known what parameter a measurement cable is meant for and it is the instruction to the engaged MULTI socket to link internally to any of the five types of embedded parameter hardware, namely:

 

Temperature, Invasive Blood Pressure, Thermo-dilution Cardiac Output, Thermistor Respiration, and FiO2

 

Thus, a coded "Smart Cable" makes it possible for exclusive use of an engaged yellow MULTI socket via internal switching among five types of specific hardware.

 

The MULTI sockets are therefore adapter sockets with the ability to take switching instructions from the digital codes stored in Smart cables

 

 

Principle of Operation

The Multi-parameter unit (MPU) in the Saturn module

 

In addition to coded Smart Cables, costly mechanism must be in place internally to select the correct active hardware corresponding to the unique code of the measurement cable being used.

The hardware sharing the two MULTI sockets are internal components of the Multi-parameter unit, together with the necessary mechanism to support the time-sharing. For example, when a measurement cable with a "Cardiac Output" code is plugged into a MULTI socket, the internal Cardiac Output hardware will have exclusive use of the engaged MULTI socket. If a hexadecimal code is not detected (such as a damaged Smart Cable plug), the MPU would not do anything and none of the internal hardware would be linked.

 

Sharing of connector sockets is made possible by coded measurement cables and an internal Multi-parameter Unit with necessary hardware

 

The MULTI PARAMETER UNIT is an official term found in the service manual

 

The MULTI-PARAMETER UNIT in the Saturn module is badly short of connector sockets

 

It is obvious the two shared-use sockets on the Saturn module are not enough for use, more sockets are badly needed. This is only alleviated by having one or two satellite boxes containing two MULTI sockets each, placed next to the Saturn module. As this is an analog solution, only four MULTI sockets can be added.

The image gives an impression of scalability when we skip the details, but all necessary hardware are already embedded in the Saturn module except for additional IBP amplifiers which must be tied to the number of available MULTI sockets.

Analog solution of up to four MULTI sockets added using external boxes

What you are seeing is making use of space external to the Saturn module to compensate up to four missing sockets on the Saturn module.

Since the MPU of the Saturn (mother) module had only two yellow MULTI sockets, it is impossible perform more than two channels of IBP monitoring; this means IBP hardware must always correspond to the number of MULTI sockets available. For this reason, each MULTI socket always come with their own one-channel IBP hardware.

Temperature hardware is not an issue since each MULTI socket can take two channels of Temperature measurements

The extension Smart module is therefore a 2-channel IBP box with two modified connector sockets. The sockets make use of their own IBP hardware when IBP monitoring is selected by the operator; for the other four parameters, the sockets can access and make use of the Temperature, Cardiac Output, Thermistor Respiration and FiO2 hardware already embedded in the Multi-parameter Unit of Saturn module.

The necessary hardware are already in the Saturn module except for additional IBP amplifiers tied to number of available MULTI sockets

So, we found a MULTI sockets hardware rule that is being kept under wraps by the manufacturer:

"Each functional yellow MULTI socket must always come with their own one-channel IBP amplifier hardware"

This of course, is the unlock key to understand when the Smart Cables are being used out of context.

The Saturn module, together with two satellite boxes adding 4 channels of IBP to the Saturn module is shown below. The four MULTI sockets on the satellite boxes can also access the MPU of the Saturn module. Together, six IBP channels and six shared-use MULTI sockets are available to the users.

The sockets on the satellite boxes compensate for the missing connector sockets on the Saturn module

A yellow shared-use MULTI socket is a high-cost serial port when it does not select any hardware

 

MULTI socket poorly utilized as a costly serial port

The initial arrangement was only for mainstream CO2 serial kit sets, but later extended enthusiastically to BIS kit set, 2nd-SpO2 kit set, APCO kit set, NMT kit set etc., whose motivation is highly questionable given this greatly increases the interface cost compared to a plain serial port.

The use of Smart Cables for serial communication, however, gives the false illusion of a mighty MULTI socket when the capabilities are in reality coming from the system software.

 

Make no mistake, the serial kit sets are self-contained and whether a particular kit set is supported depends on the system software, not on the type of connector sockets being used.

 

To reiterate, there is no difference if you connect digital serial data to the monitor using Smart Cables or ordinary serial cables

 

This is how you connect the BIS processor kit to a yellow MULTI socket

Using Smart Cables for serial interface means an unnecessary jump in demand for more yellow MULTI sockets.

 

Forceful diversion of signal path to pass through the MULTI sockets

There is no technical need for the serial kit sets to use the yellow time-shared MULTI sockets.

 

The digital serial data does not need to pass through a MULTI socket

 

 

The serial kit sets are independent self-contained packages with electronic boxes, drawing only power from the MULTI sockets. A small connector socket is all it needs for handling such digital serial data.

 

Only a small connector socket is needed for handling a one-bit digital data

 

Putting things into perspective, most patient monitoring parameters cannot be made into serial kits; it is the exception rather than the rule. Thus, although serial kit sets could be used by configured monitors for capability expansion but it is limited in scope and does not upgrade a configured monitor to be modular.

 

For example, the AE-918P Neuro Unit or a strip recorder cannot be linked to a yellow MULTI socket as serial kits.

 

The AE-918P Neuro unit and recorder module are examples that cannot make use of the yellow MULTI sockets

 

The two Modular Monitors that made use of the Saturn module were failures

 

The two modular monitors that could make use of the first Multi-parameter Module (Saturn module) made by NIHON KOHDEN were Life Scope S (BSS-9800) bedside station and Life Scope M (BSM-9510) bedside monitor; the software supporting the network infrastructure exchanging digital measurement data between the Saturn module and main units was unfortunately, not reliable and both modular monitors ended up as failures.

Life Scope S (BSS-9800) bedside station was a digital modular monitor

 

 

Lower-end Life Scope M bedside monitor was using a (6-slot) built-in module rack

 

 

 

The Life Scope M (BSM-9510) bedside monitor has lower processing power compared to the Life Scope S bedside station.

 

From the US FDA records, you could tell that Life Scope S and Life Scope M monitors were not launched in the US market

 

The two monitors were found lacking before they could be marketed in the USA market.

The cause of the failure for Life Scope S and Life Scope M modular monitors was the problematic network infrastructure needed by modular monitors for data exchange between modules and main unit. This resulted in Life Scope S bedside station functioning only as a limited monitor while the Life Scope M bedside monitor had to be withdrawn from the market due to insufficient processing power.

There were two digital real-time data network infrastructures used by BSS-9800 Life Scope S bedside station. The software supporting the Ethernet network linking patient monitors to the Central Nurse Station proved stable but the software supporting the network linking the modules to the main units of BSS-9800 bedside station/ BSM-9510 bedside monitor was unreliable and further development work on the network infrastructure was stopped to avoid incurring unbearable losses.

The exchange of measurement data between main unit and modules was problematic

 

The product failures were huge financial losses incurred at a time when the company was already suffering badly from poor sales due to the lack of digital technology know-how.

NIHON KOHDEN could not solve the communication problem between main unit and modules

 

Failure to make a functional measurement data-exchange network meant NIHON KOHDEN was downgraded to be a manufacturer only capable of making configured patient monitors

 

To avoid being seen as a failure, the manufacturer continued to promote the Multi-parameter Unit with socket boxes as options, without access to an exchange network for measurement data. The Input Unit and expansion box of Life Scope TR bedside monitor is only the equivalence of Life Scope S modular monitor's Saturn module and extension. The rest of the other modules are being solved by using external device interface, a truly configured monitor.

A Life Scope TR bedside monitor has to depend on external device interface for expansion

The Multi-parameter Unit is now being used as a smoke screen to hide the missing network infrastructure necessary for modular monitors

 

The claim that the yellow MULTI sockets make the monitors modular is merely an assertion, and the manufacturer does not provide any supporting evidence to back it up.

Life Scope TR bedside monitors are not digital modular monitors

 

The structure of Life Scope TR Input Units with its expansion unit correspond to the Philips MMS modules with its extensions. These are operating at the configured level, not modular. It will be unmistakable Life Scope TR bedside monitors are configured if there are no yellow time-shared MULTI sockets on the input units and extensions to confuse you.

 

The Philips MMS modules (initiated by Hewlett Packard) are however additionally capable of being linked to a measurement data network using Ethernet

   

HP Agilent M3/M4 portable monitor

While the Philips MMS modules can be upgraded using extensions, it also act as a server on an Ethernet network, and can be expanded by linking to a module rack with individual modules. This way, those expensive individual modules can be easily shared.

On the contrary, NIHON KOHDEN Life Scope TR Input Units cannot be linked using networking because the manufacturer does not have the capability to support this infrastructure. This is the reason Life Scope TR is not a digital modular monitor, and the manufacturer is using the yellow MULTI sockets as smoke screen to hide this weakness.

 

Think about the flexibility of a printer with network interface compared to one only equipped with a direct connection

    

The Philips MMS module (and extension) serves as the basic module and can be expanded using a measurement LAN which the Life Scope TR input units lack

The use of Smart Cables is configured

 

The yellow MULTI socket by itself does not automatically mean all the five types of mentioned parameters are available for measurements; it still depends on whether any of the five types of active hardware are actually being placed inside the Multi-parameter Unit. The amount of configured hardware inside each Multi-parameter Unit is always different; so is the system support for serial kits. If a model is not equipped with FiO2 hardware internally, no amount of yellow MULTI sockets can provide this measurement capability.

In other words, it is the built-in hardware that determine the parameter capability; and in the case of serial kit sets, the system software. This of course, is the same description as a configured patient monitor

 

 

Actual internal hardware and system support for serial kits varies for each multi-parameter unit

This means input units or monitors making use of Smart Cables are still configured. The manufacturer has no reason to continue its use; steer clear, it is not flexibility but only dabbling with distortions and limitations.

There is no customer value created by time-sharing cheap connector sockets

Elaborate time-sharing are applied to things that are expensive (high in demand, an asset), and not worth the efforts for things that are cheap (high in supply, a commodity) like a connector socket or a switch! It only makes sense to see productive efforts being made to time-share a CPU, a car, a hotel room, a yacht, an airplane but not a calculator, a pencil or a pair of scissors. The legitimate resources for a patient monitor to time-share are obviously the analog amplifier hardware and not the connector sockets or switches; this way there would not have any idling costly hardware leading to inefficient use of valuable resources!

 

Time-sharing of a car (an asset) creates value for the customers but time-sharing of a cheap connector socket does not

 

The next picture shows another manufacturer time-sharing one channel bioamplifier hardware between IBP and Temperature measurements, and there was no sharing of connector socket; this is exactly the opposite of what Nihon Kohden is doing. The said manufacturer merely ensures physically it is not possible to make use of both the PRESS and the TEMP socket at the same time.

 

Only share the expensive hardware, not the cheap sockets

 

 

A standalone BSM-1700 monitor can only have Telemetry or wired Ethernet link to the Central Monitor

 

Note a BSM-1700 monitor can only link to a central monitor using telemetry or wired Ethernet when not acting as an input unit. It is important to know the BSM-1700 transport monitor cannot communicate directly with a Central Monitor via WiFi. Though the BSM-1700 monitor can make use of a telemetry transmitter, there is no way to mount the optional ZS-900PK transmitter when the monitor is operating as an Input Unit to a host monitor.

 

Life Scope PT has no user benefit in a stand-alone operation

 

A stand-alone BSM-1700 monitor (i.e. when not acting as input unit to a host monitor) can be connected to a Central Nurse Station via the LS-NET real-time data network using wired Ethernet provided by the SC-170R AC Cradle.

Shown below is how a BSM-1700 monitor resting on an SC-170R AC Cradle is connected to the LS-NET patient monitoring network. The Ethernet socket is at the rear of the cradle and it is mandatory to protect the patient with an Ethernet isolation unit when connecting to a network.

 

The SC-170R AC Cradle does not make sense outside of Japan

 

When a BSM-1700 monitor is placed on a SC-170R AC Cradle, its function is only an ordinary stand-alone monitor but the price of a purpose-built BSM-1700 is twice that of an ordinary monitor with equivalent monitoring capability. Apart from cost, there is another problem.

Outdated Clinical Network Protocols

 

The failure of the two modular monitors (BSS-9800, BSM-9510) was a big setback to developments efforts, as many experienced engineers were being sidelined. The clinical network protocols, which define behaviors for communications on the network connecting bedside monitors and central monitors, is only in maintenance mode and lacking new initiatives.

The Life Scope Real-time patient monitoring Ethernet Protocols only work when the monitors do not move from place to place. Before the SC-170R, the monitors were always fixed to each location and patient would only be transferred from one monitor to another. With the advent of the SC-170R, the assumption no longer holds true and the old protocols need a fundamental revamp to accommodate patients moving together with their monitors while maintaining links to a central monitor.

Thus, the SC-170R AC Cradle is only meaningful for telemetry use in Japan where there is government subsidy for monitors making use of telemetry, one of entry barrier for foreign competitors. The SC-170R AC Cradle provides the power for a BSM-1700 monitor placed on it, as well as charging its internal battery for transport use. There is no similar subsidy system for telemetry monitor outside of Japan.

 

This means although a BSM-1700 monitor placed on a SC-170R AC Cradle is easily released mechanically by a lever, the BSM-1700 monitor cannot be used as a "PICK AND GO" monitor due to the outdated LS-NET clinical networking protocols.

The manufacturer had reported there would be patient location confusion at the Central Nurse Station for such a setup.

 

Life Scope PT placed on a SC-170R AC Cradle causes confusion when used with a Central Monitor!

 

 

In the above monitoring setup with a Central Monitor, the Central Monitor would still remember the last bed locations even if the patients (together with the Life Scope PT monitor) had been swapped between BED ONE and BED TWO. This is serious matter.

 

Below shows part of the relevant Note to sales teams. There is no indication that the company is capable of fixing it yet.

 

Do not use the AC Cradle with a central monitor

No, it is not simply a matter of manual adjustment

 

 

The problem is the outdated LS-NET network protocols

The Philips IntelliVue MMS X2

 

The Philips IntelliVue MMS X2 is similarly a transformation of MMS (multi-measurement server module) into a compact monitor with display and battery, primary purpose to link an MMS module to a patient and follow the patient's movement. In fact IntelliVue MMS X2 was released much earlier than BSM-1700, so there was no reason the project leader of BSM-1700 was unaware of this important need.

 

IntelliVue MMS X2 was launched long before BSM-1700

 

 

When the IntelliVue MMS X2 is connected to a host monitor, it has the option of wired Ethernet or WiFi via the host monitor OR through its own wireless telemetry transceiver to link with the Central Station. To maintain network continuity when the IntelliVue MMS X2 changes from being a MMS to transport monitor, it must choose the wireless telemetry option only. When the IntelliVue MMS X2 is assigned to a telemetry transceiver at the Central Station, patient identity is by the telemetry transceiver, thus the host monitor is automatically paired to it. The IntellieVue MMS X2 and Host Monitor together are recognized as one telemetry device to the central station.

During patient transfer, the IntelliVue MMS X2 disconnects from host monitor and operates as an independent transport monitor but communication link between MMS X2 and central station is not broken since telemetry transceiver in inside the IntelliVue MMS X2.

In addition, consider the patient arrives at a new location, the new host monitor is now paired to the IntelliVue MMS X2's telemetry transceiver monitored at the central station. Such patient transfer is truly seamless at the system level.

 

The telemetry transceiver in the IntelliVue MMS X2 is the token for tracking the patient

The Phillips Telemetry System The official name for current Philips telemetry system is IntelliVue Instrument Telemetry System (IIT) and this is a newer generation bi-directional communication system operating in groups of channels within the 2.4GHz ISM band utilizing frequency hopping algorithm. Frequency hopping technology originated from electronic warfare and is a technique to avoid enemy eavesdropping or high-power CW jamming by continuously switching the transmitting frequency (and therefore the receiving frequency). In healthcare, there is no enemy determined to jam you in every move so you do not have to anticipate the enemy. It is an adapted version to improve real-time performance in a crowded band since the 2.4GHz ISM band is a real radio waves jungle today. In the US market, Philips also offers the same IIT system using the protected WMTS bands in line with FCC initiative. This is done easily by replacing the internal ISM adapter (for International market) with WMTS adapter.

 

 

The telemetry transmitter is not always mountable on the Life Scope PT monitor

 

Despite the fact BSM-1700 monitor has a wireless option using a ZS-900PK telemetry transmitter to link to the Central Station, the telemetry transmitter cannot be attached to the BSM-1700 when it is acting as an Input Unit to a host monitor. This is because the concept of BSM-1700 as a transport monitor for the Life Scope TR was an after-thought.

 

The initial idea was to follow GE Marquette

 

The initial design was to follow GE Marquette way, transferring the input unit from Life Scope TR bedside monitor (BSM-6501 or BSM-6701) to a compact 10.4-inch Life Scope TR (BSM-6301) to fulfill the transport role.

 

The original way was to use Life Scope TR 10.4 inch model as transport monitor

 

This naturally extends to the Data Acquisition Unit (DAU) which is a repeater interface between input unit and monitor.

 

The BSM-6000 series main unit was designed long before Philips introduced the idea of turning input unit into a transport monitor

 

Thus, although the BSM-1700 monitor has a wireless option using a ZS-900PK telemetry transmitter to link to the Central Station, there is no room to attach the telemetry transmitter when BSM-1700 is acting as an Input Unit to a host monitor as illustrated.

A telemetry transmitter cannot be attached to a BSM-1700 series monitor when it is on the DAU

 

To attach a telemetry transmitter onto a BSM-1700 monitor requires the service of a qualified technical staff, it is therefore impossible for a BSM-1700 to change from being an Input Unit to a Transport Monitor with telemetry connectivity at short notice.

This means the telemetry transmitter can only be used on BSM-1700 monitor operating as a stand-alone monitor, which obviously will be an over-priced monitor and an unlikely installation.

 

BSM-1700 series monitors are not priced for stand-alone telemetry use

 

In the above image, the BSM-1700 monitor is equipped with a ZS-900PK telemetry transmitter linking to a Telemetry Central Monitor.

This is the misleading "continuous monitoring while wirelessly transmitting patient data and waveforms to a central monitor" mentioned in the brochure for use as a standalone monitor, which is meaningless to the target market outside of Japan.

 

Why is this description so out of context?

 

It is reminded the BSM-1700 does not have a built-in power unit and in telemetry mode cannot be charged directly from an AC outlet, the SC-170R AC Cradle or special external charger is additionally needed for its proper operation.

Problem exists at the system level because following Philips was an afterthought

 

The idea of turning the Input Unit on a host monitor into a Transport Monitor was not conceived yet when BSM-6000 series monitor was first designed, it was considerable time after Philips had introduced the IntelliVue MMS X2 that Nihon Kohden decided to copy the idea.

 

Life Scope PT has a serious problem of radio silence during patient transport when copying the Philips way. The image below illustrates a LIFE SCOPE BSM-1700 sitting on a Data Acquisition Unit (DAU) and connected to a Life Scope TR (BSM-6000) series host monitor. The BSM-1700 monitor in this setup is acting as an Input Unit only and master control is on the host monitor. The BSM-6000 monitor as host monitor not only provides DC Power to charge BSM-1700's internal battery, it also provides the Ethernet path (either wired or WiFi depending on BSM-6000 setting) to the Central Monitor.

 

Life Scope PT as Input Unit to a host monitor will turn into a transport monitor when detached

 

When BSM-1700 is removed from the host monitor, it can no longer use the latter's Ethernet path to the Central Monitor but it does not have its own path to the Central Monitor after leaving the host monitor. We had mentioned earlier that the BSM-1700 series monitors does not have WiFi ability.

Radio silence means it is impossible to have seamless monitoring at the central monitor

 

The communication link can only be re-established after the Transport Monitor is attached again to another Host Monitor as Input Unit. Upon re-attaching back to another host monitor, the patient data stored in the Life Scope PT during the transport period will then be synchronized to the Central Monitor.

 

Removing a BSM-1700 monitor as Input Unit on a DAU turns it offline to the Central Monitor

 

Critical central station surveillance is therefore not available for the BSM-1700 transport monitor during patient transfer from one host monitor to another. There is a critical missing specification at the system level.

The BSM-1700 relies on built-in memory to store the patient data during transport and only able to upload it to the Central Station via a Host Monitor after the transfer is completed.

Seamless data review though available at the Central Monitor, it does not equate seamless monitoring

 

 

The Central Station can be updated only after the BSM-1700 transport monitor is eventually linked to another Host Monitor as Input Unit. This synchronization will make the data on the Central Station seamless but it is not seamless monitoring.

 

As a comparison, Draeger does not need to change IP because their concept is not "from Input Unit to Transport Monitor".

>> See Draegar's "Pick And Go" Concept.

The dangerous use of semi-quantitative estimation data for uncertain measurements and concurrently displaying a flawed CO2 waveform

 

 

Nihon Kohden lacks sidestream CO2 sampling expertise and buys OEM units to offer them as expensive standalone. The AG-400 CO2 unit as shown, for example, is technology from Oridion Medical. For monitoring such as post-surgery recovery, integration of the sidestream CO2 into the monitor is a mandatory requirement because an external unit requires additional power socket besides necessitating the use of a trolley.

 

For some unknown reason, Nihon Kohden monitors could not offer integrated sidestream CO2 unit.

 

 

The inability to integrate the sidestream CO2 unit into the patient monitor main unit

Nihon Kohden solution was to offer miniaturized mainstream cap-ONE TG-920P CO2 sensor kit (order code P907) that can be used on non-intubated patients.

 

The cap-ONE TG-920P CO2 sensor kit (order code P907) has very small sensors because semi-quantitative measurement is adopted, the method is not commonly seen and many are not alerted to the risk of using data from semi-quantitative etCO2 kit sets for critical measurements and true CO2 waveform display.

 

Nihon Kohden cap-ONE P907 (TG-920P) mainstream CO2 sensor kit

 

How to remove a relatively big disposable adapter from the two tiny transducers after use?

 

When the sensors become smaller, it also means the disposable adapter becomes relatively much bigger as seen in this below picture. When trying to remove the disposable adapter from the transducers, it is difficult to separate the two because of the latching mechanism. A small size transducer means anything that latches onto it must be even smaller.

It is not easy to separate the disposable adapter from the Cap-ONE transducers after use

 

When removing disposable adapter from the mini sensors, users tend to just pull from the cables and this action quickly weakens the joint holding the sensors and cables. The action will cause stress to the two joints and quickly degenerate the performance of the transducers.

 

Users just doing the inevitable

 

Shown below is another TG-900P etCO2 kit set (order code P903) that makes semi-quantitative CO2 measurements; the TG-901T3 kit set (order code P906) is the same thing using a different connection plug. The medical devices from same manufacturer that uses semi-quantitative etCO2 kit sets for patient CO2 waveform monitoring have Life Scope patient monitors, Vismo patient monitors, Cap-STAT OLG-2800, CardioLife defibrillators and Neurofax EEG machines etc.

 

Nihon Kohden semi-quantitative etCO2 kit sets

 

A highly relevant question: Can users accept estimated measurements for patient monitoring?

    

To save costs, the semi-quantitative kit sets do not make measurement during the inspiration phase, the measurement duty cycle is as shown. This means semi-quantitative CO2 measurements are not made continuously.

Semi-quantitative means there is a duty cycle, and measurement is not continuous

 

Semi-quantitative measurement is also of low-accuracy type, performed using one IR detector instead of the usual two to save cost. This is reflected in the measurement tolerance.

 

Contrasting, quantitative measurement delivers high accuracy for critical care. To ensure the necessary high accuracy, quantitative measurement employed two IR detectors for simultaneous CO2 measurements at different wavelength for results comparison. CO2 measurements are also being made continuously.

 

Quantitative measurement employs two detectors to make continuous measurement at different wave-lengths to compare readings for high accuracy

 

NIHON KOHDEN specification for TG-901T CO2 sensor kit shows even the specified low accuracy of CO2 measurement using semi-quantitative method no longer holds true once CO2 is present during the inspiration phase.

This is because actual CO2 value will be more.

As seen from the duty cycle, there is no measurement being made during the inspiration phase; how can users know specified measurement accuracy is valid?

  

Measurements are invalid when CO2 is present during inspiration, but CO2 is not measured during this period; can you have confidence in the measurements?

 

It should be clear each semi-quantitative CO2 measurement is an estimation since its accuracy is rendered uncertain by the inability to confirm if CO2 is present during the inspiration phase. The specified measurement tolerance therefore has no meaning for the users!

 

The users are also not alerted on screen there is no CO2 measurement being made during the inspiration phase, and unknowingly made to take an unnecessary risk.

 

Semi-quantitative methodology means cost-effective estimations and the design cannot be used in a general way, only on a selective basis with known risks

 

 

For example, semi-quantitative methodology can be used as a simple estimation tool for obtaining the numerical value of End-tidal Carbon Dioxide level (etCO2).

 

Below picture shows the semi-quantitative method in the way it was intended for, estimating only the etCO2 numerical value for purpose of airway tube placement confirmation. It is not for continuous waveform display.

A hand-held semi-quantitative etCO2 estimation tool (with SpO2) for airway tube placement confirmation

 

 

How is it feasible to display a true continuous CO2 waveform when the semi-quantitative measurement kits do not have the ability to make continuous measurements?

 

 

NIHON KOHDEN also allows data from semi-quantitative measurements to be displayed on screen with the non-measurement period reset to zero level. The insistence to display a continuous waveform using discontinuous measurement data from semi-quantitative mainstream CO2 estimation kits is unacceptable; the manufacturer is just subjecting the monitored patients and users to dangerous misinterpretation risks.

 

A zero CO2 reading on the waveform means zero measured value. No measurement can only mean a defective sensor, not by design!

Note the etCO2 value shown is also not alerted as estimated etCO2 only.

 

A flawed CO2 waveform with non-measurement intervals reflected as zero measured CO2 value

As seen from the two true CO2 traces below, expiratory upstrokes do not always start from zero CO2 level!

 

Quantitative measurements confirming expiratory upstrokes do not always start from zero CO2 level

  

Check the latest updated table to make sure you only use quantitative method for critical measurements and true CO2 waveform display on screen.

 

Use only quantitative method for waveform display; the quantitative TG-950P (P905) shown here was already discontinued.

 

 

How about fully-quantitative type miniaturized mainstream CO2 sensor?

  

The TG-907P CO2 Sensor kit (order code P909) shown in above table is using quantitative method as declared. This sensor was designed for non-intubated adult CO2 monitoring, as well as neonatal CO2 monitoring. In short, Nihon Kohden is trying not to rely on others for sidestream CO2 sampling expertise.

 

The miniaturized CO2 sensor is easily broken by the bigger and stronger adapter

 

 

In addition to the dead space problem, they had not foreseen miniaturized mainstream CO2 sensors could be easily broken by the disposable adapters. This happened because the disposable adapters are now relatively bigger and stronger!

These are common defects of a TG-970P CO2 sensor kit (P909). The design is impractical.

 

 

Undeniable confirmation the fragile miniaturized CO2 sensor is of poor design, and easily broken

 

 

Key point is, it does not last

 

 

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